help...I am drowning

  1. Hi. I've been doing HH for a few weeks...had some classroom orientation, a week of shadowing and then out on my own. I have come home each night and burst into tears. I feel so responsible for these poor little people at home. One lady had such a heap of pills on her counter. I was supposed to do a med prefill. She had some in bottles, some on cards left over from the nursing home...a note from the nurse who admitted her that her doc said it was okay for her to use up the bottles before she got the scripts refilled. I could only fill 4 or was it 5 days worth of meds because she only had 5 days worth of one med...none of another. She said her daughter was going to bring it sometime...and toprol xl 50mgs when the order was lopressor 25. So she tells me 'they' cut them. Hmmm think I. The XL is long acting and the lopressor isn't but if 'they' do it I guess it's okay. I then went back to the office and thought better of it so I called a pharmacist and he told me that xl is long acting. So I called her house and spoke to her daughter. They had just gotten the lopressor script filled so I told the daughter to take the 1/2 tabs out of the pill box and use the 25s. I feel horrible that I made a mistake,even though she didn't take any of the pills.
    I've been a nurse a long time....most of my career in LTC...management. I'm not sure I'm cut out for the lose environment of home care.
    How long did it take all y'all to make the transition?
    I'm supposed to meet with my team leader on Monday. What do I tell her? That I feel incompetent and am petrified I'll make a mistake?
    I think it's time to give up nursing and do something else.
    thanks for letting me vent.
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  2. 17 Comments

  3. by   caliotter3
    Give yourself credit for digging in and addressing the problems. I have been in hh for a long time and I could give you a rundown of nurses going into homes and not attempting to correct anything, and I do mean anything. And that is not to mention the ones who document their visits to include time that they are not physically present in the home. The agency supervisors are none the wiser; if and when they find out about discrepancies, the nurses that perform poorly (or not at all when they are not in the home) are rewarded for their lack of professionalism. Whenever you find discrepancies with meds, take corrective action, whatever that may be, make the corrections on the agency documentation, document what you have done and why, and take it from there. You are emotional when you get home from work because you take your work seriously and you are worrying about outcomes. As long as you take corrective action, when you find that things are not according to hoyle, then you won't be jumped on. I would not bring up these situations to your supervisors in other than a matter of fact way to keep them (or make them) informed about the progress of the pt. Our agencies had forms called "Communication Notes". These were separate from the regular visit documentation. This is where you place info, in a factual manner, about situations that perhaps should not be addressed in regular documentation that can be read by the family in the field chart. These forms are like "quasi" incident reports. I used to fill these forms out like they were candy. That is why my supervisors complimented me on my documentation and in keeping them informed. If your agency does not have such forms, then create your own, a plain piece of paper with the pt identifying data at the top, dated with time, and write out the situation. Send in with your regular paperwork, but do not put a copy in the field chart. You need some morale boosting. Next days off, take your SO and get a restaurant meal. Don't think about the job!
  4. by   CapeCodMermaid
    Thanks for the advice. I've decided to have the meeting with the supervisor on Monday and give her my resignation. After all these years I need a break from nursing.
  5. by   cookie102
    hold on to that resignation, home health IS hard work, we are confronted with soooooooo many different situations that we have to just do the best we can...sometimes we don't work under the best situations, but try and imagine where these people would be without HH nurses!!! it takes a good 6 months to feel comfortable doing HH so don't be so hard on yourself, just ask yourself at the end of your day,{ did i do the best i could, did i make someones life better today---is my patient safe} if you can answer yes then you did your job and you did it well....hang in there!!!
  6. by   caliotter3
    Instead of resigning, I would suggest you discuss burnout and the need for a leave of absence. I don't think you had enough of a break after your last job. Have you considered a complete physical exam from your PCP? Your view of things could be clouded by physical illness, or just plain physical fatigue. Please rule everything out before you do something drastic like quitting a job.

    Please consider also: asking for your supervisor's help in identifying where you need help and what her priorities are. From your description in your original post, I saw nothing that you did incorrectly. You are too hard on yourself and are not giving yourself enough credit for what you are accomplishing. In one of your previous posts, I thought I remembered you stating that they were sending you all over the place. If that is the case, I would recommend that you tell you supervisor that you need continuity of care, assignments until you start to get the hang of things. It is an agency shortcoming that they are all over the place, and their nurses are not conscientious about their visits. Don't make that your problem. You are in learning mode and from what I see, doing an adequate, if not more than adequate job of it. You are just too tired to be able to see it. Please don't 2quit on Monday. If you have to, ask for a reduced workload that is stable until you have your energy back. The pts need you. Good luck.
  7. by   morte
    cutting the toprol should not be an issue...by cutting it she is getting the ordered med in the ordered dose in the ordered mode......it might bear checking that the discharge instructions were correct and toprol was not what the doc wanted...though i am not aware if that comes in 25 mg dose......
    Last edit by morte on Mar 26, '07 : Reason: adding a thought
  8. by   CapeCodMermaid
    Thanks for the advice. I had a long meeting with one of the supervisors today. I told her I would wait till the end of the week to see how I feel. At least today I knew 3 of the 4 patients I had to visit...sure makes it easier when you know what's up with them.
    I will consider your advice as well as my supervisor's...she basically said the same thing....huge learning curve with home care...takes getting used to being on your own...don't hesitate to ask for help......thanks again.
  9. by   CapeCodMermaid
    So I didn't quit but do have a question. How do all y'all deal with the wackos? One lady I went to see today...house is a pig sty...cats wandering about..smoke everywhere. She gets on the bed so I can do her dressing and the cat jumps up and tries to lick the open abdominal wound. I shooed it away and the lady got mad..'that's my baby'...yikes.then tell the baby to keep its tongue in its own mouth. yucko. Then I look and there is a burned down cigarette...not in the ashtray but melted into the tv remote. I told her all about the hazards of smoking when you're sleepy but I know she won't listen. So I covered myself by doing a note, but how do all y'all deal with this? I won't be surprised if I read about her in the paper under the fire department log.
  10. by   caliotter3
    As a student, one of my pts who had severe resp problems sat there in her chair with her big 'ol Oxygen tank in use and smoking a cigarette with an ashtray, and a pack of cigarettes nearby. I got understandably alarmed and spoke to her about it. Then I called my supervisor at the office right there from the home. I was told to call the MD, report the situation, and document my teaching and her response.

    Since then, any time I come across a less than positive situation, I do whatever teaching I can concerning the situation, and document everything, both on and off the daily nursing note. As long as you document teaching related to the problem, then you have done your job. You are not responsible for twisting the patient's arm to change anything. Over the course of time, they just might start to come around. However, this usually takes effort from more than one nurse to effect change. When all nurses are not making the same efforts, or are going in different directions, then there is less chance of positive outcomes.

    So in the end, document. You may not be able to perform miracles, but you will be showing, in writing, that you are doing your job to the utmost of your abilities. And when people are "whacko", it takes documentation and possible discussion at a patient care conference, to arrange referrals to social workers, psychologists, etc.
  11. by   Cattitude
    Let me add my 2 cents. Yes you need to document your teahing and instruction. Just remember that most of these people are on home care for a reason. If they could do it themselves properly, they would not need us.

    Many times they are non compliant, have psych. issues, and live in conditions we find deplorable. But it is what they are comfortable with and that is what matters. I educate on infection control and such and most often than not it goes out the other ear.

    But I try. You will see things that shock you, things that make your skin crawl. But you will carry on! That is home care.
  12. by   DutchgirlRN
    Quote from CapeCodMermaid
    So I didn't quit but do have a question. How do all y'all deal with the wackos? I cover myself by doing a note, but how do all y'all deal with this? I won't be surprised if I read about her in the paper under the fire department log.
    HH is definately a whole different side of nursing. I don't let these people bother me because the vast majority are not wackos and do appreciate the visits. Chart, chart and chart some more. I also e-mail the MSW and let her know what's going on in situations such as that. When the patient is blatently non-compliant we discharge them. i.e. they are being seen for diabetes management and teaching and refuse to comply and you see candy wrappers and cokes sitting around and they live alone. State their BS are running 120's and you check and it's 300+, we discharge after a couple of visits. i.e. we are seeing a patient for wound care and they are diabetic. They are compliant with the wound care but not with the diabetes. We continue to teach diabetes and chart like heck that they are non-compliant with their diabetes but continue to see the patient for wound care because that's the primary reason we are in there. Now we all realize that the wound would heal better if the diabetes is under control but making the patient understand that is a whole different story. Even those who have amputations continue to be non-compliant. Some things you just can't do anything about other than chart!

    Some companies don't DC for non-compliance because they don't want to lose the money but that is foolish and dangerous. It is dangerous because it puts the agency at a liability and foolish because when medicare sees that the patient is blantently non-compliant and you're continuing to see the patient they are going to refuse re-imbursement anyway stating there's no legtimate reason for SN to be in there. Good Luck, don't give up, it's frustating at first because there's so much to learn and a different way of looking at things but is rewarding in the end.
    Last edit by DutchgirlRN on Mar 31, '07
  13. by   KellieNurse06
    Hi CapeCodMermaid.....I just became a homecare nurse myself......I have dealt with homecare nurses for almost 18 years due to my daughter having home nursing care. Yes I know all too well about the whackos and people not doing their jobs.....bottom line is people just don't care anymore....not all but alot. They are just in it to collect a paycheck, and yes they do seem to get away with slacking off...but will be the 1st to complain about others.
    You are doing visiting nurse, correct? Well maybe you'd perhaps consider block time??? That's what I do (& I have coming into my home for my daughter) You really give 1 on 1 care the way it should be...and you may enjoy that instead of the visits to multiple patients per day.
    Just an idea before you give up ......you can go orient to cases you choose & decide if you want to do them or not...and you get paid even for orientation. Maybe give that a shot???? I work for a peds agency & another that does both adults & peds. The beauty of it is you can make your own work days & choose which cases you want to take...you don't "Have" to go to who they assign you to.........the two I work for are good.....the peds one I work for actually has my child, so when the nurses come ....I can go to work for the cases I do.......if you want any info on the agencies I work for pm me & I will give it to you...heck you can even use me as a reference if you'd like.....let me know! Please don't get frustrated it's not worth it....
  14. by   CseMgr1
    Quote from KellieNurse06
    Hi CapeCodMermaid.....I just became a homecare nurse myself......I have dealt with homecare nurses for almost 18 years due to my daughter having home nursing care. Yes I know all too well about the whackos and people not doing their jobs.....bottom line is people just don't care anymore....not all but alot. They are just in it to collect a paycheck, and yes they do seem to get away with slacking off...but will be the 1st to complain about others.
    The last HHA I worked for was filled with people who basically didn't give a flying damn, as LONG as they were able to write their own checks and schedules. It was a very toxic environment, propogated by a "good ol' boy" administration and a Director who was afraid of her own shadow. As soon as I discovered that my authority as a supervisor was being undermined, I left...and haven't looked back.

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